Geriatrics needs among rural older Veterans receiving virtual mental health services

Abstract: PURPOSE: Rural older Veterans have limited access to specialty care. In the Veterans Health Administration (VHA), tele-geriatric mental health (tele-GMH) services provide mental health care to older Veterans through regional telehealth hubs. However, older Veterans may still face gaps in access to geriatric medicine and specialty services, exacerbating unmet needs at the intersection of mental and physical health. We assessed unmet needs for geriatric medicine and related specialty services for rural older Veterans served by tele-GMH. METHODS: We surveyed 32 clinicians in 6 VHA geographic regions who referred Veterans to tele-GMH services in fiscal year 2023, 25 of whom served rural Veterans. We also conducted semi-structured interviews with 11 tele-GMH clinicians. Survey data were summarized using descriptive statistics, and interviews were analyzed utilizing rapid qualitative analysis. We also described workflows of tele-GMH clinicians as they align with the "4Ms" of age-friendly care (Mentation, Medications, Mobility, What Matters). FINDINGS: Referring clinicians serving rural Veterans reported lower access to geriatricians than those serving both rural and nonrural Veterans (14.3% vs 36.4%, respectively). Reported access to additional specialty services, as well as local aging services, was also limited. Based on interviews, facilitators for connecting Veterans to services included tele-GMH clinicians' knowledge of local resources. Tele-GMH clinicians reported barriers including high demand, geography, and frequent staff turnover. Tele-GMH clinicians highlighted the utility of the 4Ms to enhance quality of care. CONCLUSIONS: Integrating geriatric medicine into tele-GMH programs supports the delivery of high-quality, age-friendly health care, optimizing VHA workforce capacity and improving care coordination within VHA and non-VHA systems.